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Review examines complications after deep extremity implant removal in children
Davids JR. J Bone Joint Surg Br. 2010;92(7):1006-1012.
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The overall complication rate after deep extremity implant removal in children was 12.5%, according to the results of this retrospective review.
Researchers at Shriners Hospital in Greenville, S.C., observed 801 children who had 1,223 implants removed over 17 years. Their goal was to define the nature, risk and rate of complications with the procedure.
Jon R. Davids, MD, and colleagues performed a bivariate analysis that assessed possible predictors, implant insertion-related complications, indications for removal and the complications that occurred during removal. Based on the bivariate analysis, the researchers created a logistical regression model.
Overall, 100 complications occurred in 801 patients. There were 48 major (6%) and 52 minor (6.5%) complications.
The researchers found that four predictors increased the chance of having a major complication after implant removal:
- a complication after initial implant insertion;
- a non-elective indication for removal;
- a neuromuscular disease associated with a seizure disorder; and
- a neuromuscular disease in nonambulatory children.
Children who had all four of these predictors were 14.6 times more likely to have a major complication, the authors wrote.
This study provides worthwhile insight into a common dilemma facing orthopedic surgeons. The authors did an excellent job of focusing on clinical factors statistically associated with a higher complication risk. The findings confirm what one would expect intuitively; increased risks associated with having a neuromuscular abnormality, seizure disorder and inability to walk as well as the increased risk following a complication from the initial surgery.
The authors note a higher overall complication rate (12.5%) than we noted in our review of the English literature (6% exclusive of SCFE cases). This may be attributable to the diligent reporting of minor complications that were not included in the majority of previously published articles.
– Ellen Raney, MD
Chief of Staff
Shriners Hospitals for Children, Honolulu
Clinical Professor
Departments of Surgery and Pediatrics
University of Hawaii
- Reference:
Raney EM, Freccero DM, Dolan LA, et al. Evidence-based analysis of removal of orthopaedic implants in the pediatric population. J Pediatr Orthop. 2008;28:701-704.